Searching for SARS-CoV-2 origins: the saga continues
Authors: None The Lancet Microbe
Journal: The Lancet Microbe (2022)

On June 9, the first preliminary report of the Scientific Advisory Group for the Origins of Novel Pathogens (SAGO) was published, representing the work of the group so far in distilling the questions that need to be asked to understand the origins of the COVID-19 pandemic and future pandemics. Given the ongoing nature of this work, it is likely to evolve as information is uncovered and new gaps are identified, just as all scientific enquiries should. However, this open-ended approach does create an opportunity for political interference at some level. The members of SAGO are tireless volunteers who have embraced the challenge of formulating recommendations in a politically charged setting. Much current interest in the work of SAGO predictably centres on how SARS-CoV-2 entered the human population, but it is intended to have a greater legacy: “to inform the actions needed each time an emerging or re-emerging pathogen is identified and causes human infections”. A feature that particularly stands out is that anthropology is part of the recommended elements of the framework put forward by SAGO. Anthropology stands out for two reasons: first, it is hard to imagine how an endeavour such as this could succeed without it and, second, post-outbreak audits often comment on the need for it when tackling the next outbreak. Unfortunately, the nod towards anthropology in many outbreak investigations is often lip service, so the inclusion in the SAGO recommendations as a founding principle offers some hope. At the other end of the spectrum there are the recommended elements of biosafety and biosecurity. These considerations are almost ubiquitous in any discussion about emerging pathogens and large-scale outbreaks. They often reflect the instinct of many authorities to be inward looking and to rely on technological responses. Such reactions tend to lack the long-term benefits of addressing the underlying social factors that make us vulnerable to repeated outbreaks, but they appeal to those whose buy-in is necessary if the work of SAGO is to make it out into the world. A repeated warning in the report, regarding the origins of COVID-19, is that key pieces of data are not yet available to allow a complete understanding of how the pandemic began. Given during earlier assessments of COVID-19 origins there were warnings that the window was closing for new evidence, one has to wonder if evidence to complete the picture will ever be forthcoming. Nonetheless, in the report, SAGO seeks to fill the gaps in the evidence by making key recommendations for further human, animal, and environmental studies both within China and worldwide. In addition to new studies, it is highlighted in the report that there are samples in existence that might provide greater insight: samples from the market in Wuhan in January 2020 that tested positive for SARS-CoV-2 and human samples from various pre-pandemic national surveillance programmes for influenza and other respiratory pathogens from anywhere in the world. Although SAGO was not formed to uncover the origins of SARS-CoV-2, their role to offer guidance on the studies needed to gather relevant evidence puts them at the centre of the process, meaning that they have the power to shape outcomes. In the background to the establishment of SAGO, it is stated that “understanding the source of a virus emergence that leads to a pandemic is difficult yet crucial to understanding how to prevent a similar event in the future”. But it is open to interpretation if identifying the source allows for the prevention of future events, as this risks the familiar failing of preparing for the last pandemic, not the next one. Put simply, we have a working understanding of what is needed to mitigate future pandemics even if we do not know the exact source or route of the new pathogen into the human population. It is not the intention of SAGO to apportion blame; however, many nations are clearly eager to point the finger. The potential problem here is the conflict between scientific and political approaches. To discover the source of an outbreak we must work forward without preconceptions, following wherever the evidence leads. However, to create policy we must work backwards from our desired outcome to map out the steps that will lead us to our goal. Done sequentially these approaches are synergistic, but the concern is that when these approaches are done in parallel or conflated, we have the worst of both worlds: selective enquiry to inexorably lead to the desired conclusion. For the SAGO preliminary report see https://www.who.int/publications/m/item/scientific-advisory-group-on-the-origins-of-novel-pathogens-report For the SAGO preliminary report see https://www.who.int/publications/m/item/scientific-advisory-group-on-the-origins-of-novel-pathogens-report